A 47-year-old woman with hyperthyroidism treated with radioiodine is examined. She developed hypothyroidism 5 months later and was treated with thyroid hormone. Four months later, progressive muscular hypertrophy was noted. She was fatigued and complained of cramping and restricted movement as a result of the muscle bulk. Slow deep tendon reflexes were noted on physical examination. The diagnosis of Hoffmann's syndrome was made. This is a rare entity in the spectrum of hypothyroidism. Physicians should remember that myopathy can be the presenting symptom complex in hypothyroidism
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